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(Circulation. 1997;96:238-245.)
© 1997 American Heart Association, Inc.
Articles |
Effect of Sympathoinhibition on Exercise Performance in Patients With Heart Failure
From the Division of Cardiology and Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tenn.
Correspondence to John R. Wilson, MD, Division of Cardiology, 315 MRB II, Vanderbilt University Medical Center, Nashville, TN 37232.
Background In patients with heart failure, excessive sympathetic activation during exercise could interfere with exercise performance by impairing arteriolar dilation in working muscle and by adversely altering skeletal muscle metabolic behavior. To test this hypothesis, we examined the effect of sympathoinhibition with clonidine, a central sympatholytic agent, on skeletal muscle blood flow and metabolism in patients with heart failure.
Methods and Results Swan-Ganz and femoral venous catheters
were inserted in 20 patients with chronic heart failure and exercise
intolerance (peak exercise 
O2=9.3±1.4
[SEM]
mL·min-1·kg-1).
Central hemodynamic measurements, leg blood flow
determined by thermodilution, and systemic and leg
metabolic parameters were measured during
maximal treadmill exercise before and 2 hours after clonidine 2 µg/kg
IV (n=15) or 0.9% normal saline (n=5). During control exercise before
the administration of clonidine, leg blood flow increased from 0.3±0.1
to 1.8±0.2 L/min and plasma norepinephrine increased from
485±61 to 2155±186 pg/mL (both P<.01). Treatment with
clonidine markedly suppressed norepinephrine levels during
exercise (matched peak exercise workload: control, 2137±187 versus
clonidine, 1430±161 pg/mL), increased leg blood flow (control,
1.8±0.2 versus clonidine, 2.3±0.4 L/min), reduced systemic oxygen
consumption (control, 1002±70 versus clonidine, 966±68 mL/min),
reduced pulmonary artery lactate concentration (control,
3.2±0.3 versus clonidine, 2.6±0.2 mEq/L), and decreased minute
ventilation (control, 39.7±2.1 versus clonidine, 34.9±2.4 L/min) (all
P<.05).
Conclusions These findings suggest that sympathetic activation during exercise reduces leg blood flow, increases muscle glycolysis, and decreases muscle efficiency in patients with heart failure.
Key Words: heart failure • catecholamines • clonidine • regional blood flow • exercise • muscles
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